The Joint Commission Core Measures

Check List Card

 

AMI

CHF

Pneumonia

Indicators During Admission

√ ASA within 24 hrs

√ Beta Blockers within 24 hrs

√ ACE Inhibitor/ARB

√ Smoking Cessation

advised/counseling

Indicators During Admission

√ Document LVEF

√ ACE Inhibitor/ARB (If LVEF <40%)

√ Smoking Cessation

advised/counseling

Indicators During Admission

√ First dose of antibiotic within 4 hrs from

triage

√ Oxygen assessment within 24 hrs

√ Blood cultures done prior to antibiotics

√ Appropriate antibiotic selection

√ Smoking Cessation

advised/counseling

Indicators at Time of Discharge

√ ASA

√ Beta Blockers

√ ACE Inhibitor/ARB

√ Smoking Cessation

advised/counseling

 

 

Indicators at Time of Discharge

√ ACE Inhibitors/ARB (If LVEF <40%)

√ Smoking Cessation

advised/counseling

√ Discharge Instructions: (all 6 must

be documented)

          Activity

          Diet

          Follow-up appointments

          Medication instructions

          Weight monitoring

          What to do if symptoms worsen

Indicators at Time of Discharge

√ Pneumococcal screen/vaccination

√ Influenza screen/vaccination

√ Smoking Cessation

advised/counseling

Please document contraindication or reason for omission for any of the above medications.

Reminder-AMI, CHF and Pneumonia Pathways are available in the ECC.

 

 

 

 

 

 

 

 

 

 

 

 

 

DVT Prophylaxis

 

Low-risk factors (Prophylaxis is generally indicated if TWO OR MORE of these are present)

 

Moderate-risk factors (Prophylaxis is generally indicated if ANY of these are present)

 

Major-risk factors (Prophylaxis is generally indicated if ANY of these are present)

          Minor surgery (less than 45 minutes)

          Age 60-74 years

          Hip/Knee arthroplasty

          Oral contraception or hormone replacement therapy

          Factor V Leiden/Activated protein C resistance

          Multiple trauma within last 30 days (nonambulatory patients)

          Age 41 - 59 years

          History or family history of thrombosis

          Hip/pelvic fracture in last 30 days

          Recent (less than 30 days) major surgery

          Current or history of malignancy

          Acute spinal cord injury within 30 days

          Varicose veins

          Major surgery more than 45 minutes

          Long bone fractures

          Inflammatory bowel disease

          Patient confined to bed more than 72 hours

 

          Obesity (BMI more than 30)

          Acute or decompensated heart failure

 

          Acute myocardial infarction

          Nonhemorrhagic stroke within last 30 days

 

          Pregnancy or postpartum within 30 days

          Congenital or acquired thrombophilia

 

          Compensated heart failure

 

 

          Serious lung disease/ current smoker

 

 

          Nephrotic syndrome

 

 

          Laparoscopic surgery

 

 

          Elective spinal surgery

 

 

DVT Prophylaxis Contraindications

Absolute: If any box is checked, pharmacologic anticoagulation is not recommended; use mechanical prophylaxis if indicated

Relative: Balance risks and benefits before determining best option for individual patients

          History of heparin-induced

thrombocytopenia (HIT)

          Epidural or spinal tap within last 12 hours

          Uncontrolled hypertension*

(SBP >200, DBP >120, crisis)

*MD, please reassess in 24

hours

          Coagulopathy (PT >18 seconds)

          Patient is currently

Anticoagulated

          Active bleeding

          Intracranial

bleed/neoplasm/monitor

          History of cerebral hemorrhage

          History of GI or GU bleed in

last 6 months

          Solid organ laceration

          Intracranial or intraocular

surgery within last 14

days

          Spinal injury/surgery

          Thrombocytopenia

(platelet < 50,000/mL)

          Proliferative retinopathy

          Renal failure on dialysis

          Biopsy site or vascular device inaccessible to compression

          Epidural catheter removal

within 4 hours